OUTCOME AMONGST PATIENTS REGISTERED UNDER …

1 JOURNAL OF INTERNATIONAL ACADEMIC RESEARCH FOR MULTIDISCIPLINARY Impact Factor , ISSN: 2320-5083, Volume 2, Issue 4, May 2014 153 OUTCOME AMONGST PATIENTS REGISTERED UNDER REVISED national tuberculosis control PROGRAMME OF INDIA AFTER THREE YEARS OF COMPLETION OF TREATMENT DR. RAHUL RAMESH BOGAM* SUNIL M. SAGARE** *Assistant Lecturer, Dept. of Community Medicine, Bharati Vidyapeeth Deemed University Medical College, Pune, India **Associate Professor, Dept. of Community Medicine, Bharati Vidyapeeth Deemed University Medical College, Pune, India ABSTRACT India accounts for nearly one fifth of global problem of tuberculosis . Revised national tuberculosis control Programme (RNTCP) came into existence by formulating and adopting internationally recommended DOTS strategy as a most systemic and cost-effective approach to revitalize tuberculosis control programme in India.

2 Despite high cure rates, several queries have been raised about the effectiveness of RNTCP regimens including inadequate diagnosis, wrong categorization, methods of administration and possibility of increased rate of MDR TB. The present study was carried out to assess various outcomes AMONGST PATIENTS REGISTERED UNDER RNTCP during 2007 at Pune, India. The present study was carried out in areas covered by Sahakarnagar tuberculosis Unit of Pune Municipal Corporation, Pune. All TB PATIENTS who had been REGISTERED during period of 1st January 2007 to 31st December 2007 UNDER RNTCP were followed up for study purpose. Treatment success rate in present study was and very few number of symptomatic subjects 9( ) of which, 4( ) had URTIs, 2( ) had allergic bronchitis and three ( ) were relapsed cases. RNTCP was found to be effective as revealed by present study where treatment success rate was more than any other unfavourable outcomes in study subjects.

3 KEYWORDS: Follow Up, OUTCOME , RNTCP, Symptomatics, tuberculosis INTRODUCTION India accounts for nearly one fifth of global problem of tuberculosis . Everyday more than 20,000 people become infected with TB bacilli. Almost two people die of every three minutes in our country. Unfortunately, despite the existence of national tuberculosis control Programme since 1962 to 1992, desired results were not achieved. RNTCP came into existence by formulating and adopting internationally recommended DOTS strategy as a JOURNAL OF INTERNATIONAL ACADEMIC RESEARCH FOR MULTIDISCIPLINARY Impact Factor , ISSN: 2320-5083, Volume 2, Issue 4, May 2014 154 most systemic and cost-effective approach to revitalize tuberculosis control programme in India. (4) The goal of RNTCP is to reduce morbidity and mortality associated with tuberculosis and to break the chain of transmission of infection until TB ceases to be a public health problem.

4 The first objective is to achieve and maintain cure rate of at least 85% among newly detected smear positive cases and to achieve and maintain detection of at least 70% among chest symptomatics in community. (4) Treatment success rate of tuberculosis has been increased from 25% to 86%. Death rate has been brought down seven fold from 29% to 4%. Despite high cure rates, several queries have been raised about the effectiveness of RNTCP regimens including inadequate diagnosis, wrong categorization, method of administration and possibility of increased rate of Multidrug Resistant tuberculosis . (MDR-TB). (6) Till date very few studies have been conducted to find out the current status of PATIENTS REGISTERED UNDER RNTCP of India. Therefore present study was carried out to assess the present status of PATIENTS REGISTERED UNDER RNTCP during 2007 at Pune City, India.

5 OBJECTIVE To assess the various outcomes AMONGST the tuberculosis PATIENTS after three years of completion of treatment UNDER RNTCP Programme of India. MATERIAL AND METHODS 1. Study area The present study was undertaken in areas covered by Sahakarnagar tuberculosis Unit, Pune which is located in South Zone of Pune City of Maharashtra State of India. The tuberculosis Unit (TU) caters for approximately lakh population. There are total 90 DOT centers and 90 DOT providers UNDER the said centre. 2. Study design A Cross Sectional Study 3. Study population The study population comprised of all PATIENTS who had been REGISTERED during period of 1st January 2007 to 31st December 2007 UNDER Revised national tuberculosis control Programme (RNTCP) in Sahakarnagar tuberculosis Unit, Pune. JOURNAL OF INTERNATIONAL ACADEMIC RESEARCH FOR MULTIDISCIPLINARY Impact Factor , ISSN: 2320-5083, Volume 2, Issue 4, May 2014 155 4.

6 Sample size estimation Personal visit was done to Sahakarnagar tuberculosis Unit (TU), Pune. A total number of PATIENTS REGISTERED UNDER RNTCP as per TB register maintained at TU were 896 for the period of 1st January 2007 to 31st December 2007. After applying exclusion criteria (excluding persons less than 15 years of age 35), the sample size (n) for study was 861 (896-35). To test the sampling adequacy, The KMO (Kaiser - Meyer - Olkin) (1) test was applied. The KMO index ranges from 0 to 1, with considered suitable for factor analysis. For present study, KMO value was (approximately ). Hence the sample size of 861 in the present study was found to be adequate. 5. Time utilization calendar A. Preliminary planning of study Four months (May 2010 August 2010) It includes: A1. Arriving at final decision to conduct a cross sectional study and preparation of questionnaire.

7 A2. Submission of research protocol for approval from ethics committee. (The study was approved by Institutional Ethics Committee Letter no BVDU/MC/1556/2010-11). B. Pilot testing of questionnaire - Two months (September 2010 October 2010) C. Data collection months (November 2010 to November 2011) time required for interviewing study subject with recording of information in proforma was 40-45 minutes. D. Analysis of data - Six months (December 2011- May 2012) 6. Selection of study subjects Inclusion Criteria All PATIENTS who had been REGISTERED during period of 1st January 2007 to 31st December 2007 UNDER RNTCP in Sahakarnagar tuberculosis Unit, Pune. Exclusion Criteria All PATIENTS less than 15 years of age. JOURNAL OF INTERNATIONAL ACADEMIC RESEARCH FOR MULTIDISCIPLINARY Impact Factor , ISSN: 2320-5083, Volume 2, Issue 4, May 2014 156 7.

8 Collection of data A list of study subjects during specified period was obtained from tuberculosis Register (TB Register) maintained at Sahakarnagar tuberculosis Unit (TU), Pune. Information about their name, age, sex, address, initial sputum smear result, treatment category, date of start of treatment, sputum smear result during and at the end of their treatment and OUTCOME was collected from the tuberculosis register maintained at TU. All the subjects along with their addresses were approached by door-to-door visit with the help of a health visitor and stake holders of communities. Maximum three attempts were done to trace out the subject. The subjects with more than three attempts to trace out were included in category of not traceable . Informed consent was taken from subjects who were traced after three years of treatment to participate in the study.

9 During visit every effort was taken to relax the subject. He/she was explained about the nature of study and was assured that the information given by him/her is required only for study purpose and will be kept confidential completely. Written informed consent was taken from subjects who were willing to participate in study. Relevant information about socio demographic characteristics of subject, detailed information regarding present complaints and its duration, past history and family history pertaining to tuberculosis was noted in pretested and predesigned proforma. History of risk habits like tobacco, smoking, alcohol with their duration and frequency was noted. Symptomatic subjects were clinically evaluated. Information about clinical evaluation was filled up in respective proforma. The study subjects with symptoms suggestive of tuberculosis were referred to various hospitals in their residential areas where diagnostic facilities for tuberculosis (sputum smear and radiological examination) were available.

10 Examination report of referred subjects was confirmed. Every subject was specifically counselled for treatment compliance, adoption of healthful habits etc. On an average, 40-45 minutes were required to collect information from each study subject. On each day, two to three subjects were covered. 8. Data analysis After collection and editing of data, classification and tabulation was done UNDER appropriate heading so as to obtain the summary values for further statistical treatment. JOURNAL OF INTERNATIONAL ACADEMIC RESEARCH FOR MULTIDISCIPLINARY Impact Factor , ISSN: 2320-5083, Volume 2, Issue 4, May 2014 157 Statistical analysis was done by using analysis tool pack from Microsoft Office Excel, and SPSS 15 statistical package. RESULTS AND DISCUSSION The study was carried out to determine the present status of subjects REGISTERED UNDER RNTCP with respect to tuberculosis .